Individuals with eczema frequently have problems with self-image and self-esteem. Their skin condition interferes with peer-group relationships, and the sleep disturbance often results in a continuous source of stress for the family.
Sources of stress should be identified, including marital separation and teasing from peers or siblings. Psychological counseling can help deal with feelings of guilt, anxiety and anger that may arise. In situations where stress triggers increased scratching, behavior modification can be useful in channeling the scratching into more useful activities. Art therapy and play therapy may also be helpful.
For patients with excessive anxiety, depression, itching and sleep difficulties, psychotropic drugs may be required. Benzodiazepines and buspirone are helpful anxiolytics that have been used to control anxiety in atopic dermatitis. Doxepin at bedtime can also help control the itching that disturbs sleep. In some patients, depression can interfere with their ability to follow a skin-care routine. Such individuals may benefit from treatment with antidepressant drugs such as tricyclics or specific serotonin reuptake inhibitors (SSRIs).
In patients with poorly controlled atopic dermatitis, psychiatric referrals should be considered not only for pharmacologic intervention but to identify situations and patterns of behavior that are stressful and trigger flares.